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Nicola Zerbinati,1 Anna P&lstrok;atkowska,2 Stefania Guida,3,4 Giorgio Stabile,3,4 Roberto Mocchi,5 Chiara Barlusconi,6 Sabrina Sommatis,5 Leonardo Garutti,7 Raffaele Rauso,8 Giovanna Cipolla,9 Luca Bettolini,10,&ast; Stefano Bighetti10,&ast; 1Dermatology Unit, University of Insubria, Varese, Italy; 2Dermatology Unit, Anclara Health &Aesthetics, Warsaw, Poland; 3Dermatology Unit, Università Vita-Salute San Raffaele, Milan, Italy; 4Dermatology Clinic, IRCCS San Raffaele Scientific Institute, Milan, Italy; 5Microbiology and Biochemistry Department, UB-CARE S.r.l.-Spin-off, University of Pavia, Pavia, Italy; 6Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy; 7Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; 8Maxillofacial Surgery Unit, Clinica Parioli, Rome, Italy; 9Dermatology Unit, Centro Medico Polispecialistico, Pavia, Italy; 10Dermatology Unit, University of Brescia, Brescia, Italy&ast;These authors contributed equally to this workCorrespondence: Luca Bettolini; Stefano Bighetti, Dermatology Unit, University of Brescia, Brescia, 25123, Italy, Tel +39 030 3995301, Fax +39 030 399505, Email l.bettolini@unibs.it; s.bighetti@unibs.itPurpose: This prospective, single-center study aims to evaluate the safety and effectiveness of NEAUVIA Intense, a PEG cross-linked polymeric hydrogel, in correcting moderate-to-severe nasolabial folds (NLF) in a routine clinical setting. The study investigates the aesthetic outcomes, patient satisfaction, and adverse events associated with the injectable filler.Patients and Methods: Seventy patients were initially enrolled, with 60 meeting study parameters. The post-market study involved a single session treatment, employing NEAUVIA Intense on each side of the NLF. Assessments utilized the Modified Fitzpatrick Wrinkle Scale (MFWS), Global Aesthetic Improvement Scale (GAIS), and Visual Analogical Scale (VAS).Results: The study demonstrated a statistically significant improvement in tissue depression immediately post-injection (p < 0.001), with sustained effects up to 6 months. MFWS assessments revealed that responder patients were 96.6% immediately after treatment, 76.6% one month, 48.3% after 3 months, and 28.3% at 6 months (p < 0.001). Additionally, there was a significant change in the frequency distribution of MFWS scores post-treatment (p < 0.001), with the majority of patients experiencing improvement in tissue depression. Maximum improvement was observed at 30- and 90-days post-treatment based on GAIS assessments. Patient and physician satisfaction, measured by VAS, remained stable over time, with fluctuations at 4 and 24 weeks after treatment (p < 0.001, Anova; p < 0.05, Wilcoxon). Throughout the entire follow-up duration of the patients enrolled in the study, no adverse effects related to the use of the product were observed.Conclusion: NEAUVIA Intense proved to be an effective solution for correcting NLF, providing significant and lasting improvements in tissue depression and aesthetic outcomes. The study underscores the necessity for continuous assessment in aesthetic medicine to align outcomes with evolving patient expectations and optimize long-term results. The findings contribute to the understanding of this specific hydrogel filler and highlight the broader context of injectable fillers in comprehensive facial aesthetic strategies.Keywords: dermal fillers, nasolabial folds, hyaluronic acid fillers, PEG cross-linked hydrogel, facial aging

Background: Orbital exenteration is a severe and disabling surgical procedure that involves the removal of all orbital contents. Effective reconstruction is crucial to managing the resulting defects. This study aims to propose a reconstructive algorithm utilizing free flaps derived from the lateral circumflex femoral artery (LCFA) system for orbital exenteration defects, based on our clinical experience., Patients and Methods: Patients who underwent orbital exenteration and subsequent reconstruction using LCFA-based free flaps between January 2013 and January 2022 were included in this study., Results: A total of 44 patients underwent orbital exenteration, followed by LCFA free flap reconstruction. The choice of reconstructive technique depended on defect type and dura mater exposure, adhering to the proposed algorithm. The procedures included 20 standard ALT (Anterolateral thigh) flaps, 13 chimeric ALT flaps, 1 SALT chimeric flap with skin grafting, 7 SALT flaps with skin grafting, and 3 buried SALT flaps. Complications were recorded in 10 cases at the recipient site and 2 cases at the donor site., Conclusion: Orbital exenteration presents significant challenges both surgically and reconstructively, with a high risk of local recurrence and postoperative mortality. The reconstruction algorithm using LCFA-based free flaps, as proposed in this study, may guide surgeons in selecting the most appropriate technique, tailored to the specific defect and considering postoperative treatments such as adjuvant radiotherapy., (Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Facial lymphedema (FL) is a potential complication following head-and-neck tumor (HNT) therapy. Conservative management is often difficult, and there is limited literature on surgical treatments for FL. This report presents three cases of FL treated with lymphaticovenular anastomosis (LVA). All three patients were male with ISL stage 2 FL following treatment for oral squamous cell carcinoma, aged 59, 45, and 55 years. In each case, double end-to-end LVAs were performed in the preauricular region (right side in cases 1 and 3, left side in case 2). Follow-up was 12 months for cases 1 and 2 and 9 months in case 3, with no post-operative complications. Case 1 showed a 4% reduction in two of three anthropometric parameters, case 2 demonstrated an 8% reduction in all the parameters along with quality-of-life improvement, and case 3 had a 6% reduction in all parameters with improvement in both pinch test and quality-of-life. LVA supermicrosurgery appears to be an effective treatment for FL, improving quality of life with minimal complications and no need for further surgical interventions., (© 2025 Wiley Periodicals LLC.)

The best breast reconstruction solution after mastectomy remains a topic of wide debate. Recently, the focus in the field of implant-based reconstruction has been on the increasing indications for prepectoral reconstruction. This offers undoubted advantages over subpectoral reconstruction, ranging from better aesthetic results and patient comfort to a less invasive procedure that spares the pectoralis major muscle, reducing pain and postoperative recovery time. The dermal sling is a reconstructive variant introduced by Bostwick in the 1990s and is commonly used to complete the subpectoral pocket in one- or two-stage reconstruction, creating a dual-plane reconstruction. This method may be indicated after mastectomy for both therapeutic and prophylactic purposes. It can also be used for unilateral and bilateral reconstructions. We propose a new meshed dermal sling technique that allows complete prepectoral reconstruction without the use of acellular dermal matrix, thus reducing the cost of reconstruction. It also allows the indication for complete prepectoral reconstruction to be extended to patients with medium breast volume and grade 1 or 2 ptosis, without the need to use acellular dermal matrix or the pectoralis major muscle to complete the breast pocket., Competing Interests: The authors have no financial interest to declare in relation to the content of this article., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Background: Animal-derived acellular dermal matrices (ADMs) are increasingly being used in prepectoral direct-to-implant (DTI) breast reconstruction. However, the indications and complication profile associated with this type of reconstruction remain unclear. This study aimed to perform a systematic review of the available literature on the use of animal-derived ADM in prepectoral DTI breast reconstruction., Methods: Three different literature databases, namely, PubMed, Web of Sciences, and Embase were screened using the following keywords: "immediate" AND "pre-pectoral" OR "prepectoral" AND "ADM breast reconstruction." Animal-derived ADM used (porcine - Braxon® and non-Braxon® - and bovine - Surgimend®) anthropometric information, clinical data, and complications profile were considered., Results: A total of 340 articles were initially identified, of which only 45 articles (5089 patients and 6598 reconstructed breasts) satisfied our inclusion criteria. The most widely used ADM was Braxon® in the context of conservative mastectomies. In most studies, a subcutaneous layer > 1 cm and lack of previous radiotherapy were considered prerequisites for this type of reconstruction. An increased risk of complications was found in smokers, patients who underwent radiation treatment, patients with high breast volumes, and patients with cancers requiring axillary dissection. Data related to the role of diabetes, high body mass index, and breast implant size on surgical outcomes were instead inconcludent. Age was not directly proportional to the complications., Conclusion: The complications associated with different animal-derived ADMs are generally comparable. The profile of patients required for eligibility for this type of reconstruction appears to have been identified and is in line with current recommendations., Competing Interests: Declaration of Competing Interest The authors have no conflict of interest to declare., (Copyright © 2023 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: Nerve injuries are a common occurrence among hand injuries, which at the time of the COVID-19 emergency, did not appear to have reduced their incidence. The treatment of these injuries is urgent, but the pandemic has led to a reduction in the availability of resources and a consequent reorganization of activities. Principles about Wide-Awake Local Anesthesia No Tourniquet (WALANT) in hand surgery expressed by LaLonde helped hand surgeons to adapt to this new condition by demonstrating a possible outpatient pathway for the treatment of hand traumatic conditions. In the present study, we bring our experience in nerve repair at time of COVID-19 emergency., Methods: We retrospectively enrolled in this study all patients surgically treated for a peripheral nerve injury (PNI) during the COVID-19 emergency period from March 2020 to March 2022. Demographical, anamnestic, surgical, and postoperative data were recorded and analyzed. Persisting Tinel was set as the primary outcome, while hypoesthesia and other complications as secondary outcomes., Results: Thirty-six patients have been enrolled. Despite some difference in group homogeneity in term of hypertension and multi-digital involvement, we registered no difference in term of outcomes ( P  > 0.05) between patient operated in surgical theater and in outpatient clinic and between the various techniques of nerve repair employed ( P  > 0.05)., Conclusions: Nerve repair on an outpatient facility is technically feasible and was found in this study to be safe and effective. Compared to hospitalization, the outpatient setting has a more "agile" organization and lower costs, making it preferable in selected cases.Level of evidence: Level IV, Therapeutic., Competing Interests: Competing interestsLeonardo Garutti, Federico Tamborini, Alessandro Fagetti, Tommaso Baroni, Elisa Bascialla, Andrea Minini, Mario Cherubino, and Luigi Valdatta declare no conflict of interest., (© The Author(s) 2023.)

Competing Interests: Conflict of interestMarcasciano M, Kaciulyte J, Di Giuli R, Nanni J, Frattaroli JM, Garutti L, Cherubino M, Lo Torto F, Fioramonti P, Ribuffo D, and Casella D declare no competing interests.

Upper limb burn treatment represents a major medical and surgical challenge. Enzymatic escharolysis is a rather new technique to treat thermal burns in an easy and rapid way, as an alternative to the standard of care. The aim of the study was to investigate and describe the efficacy of treatment of upper limb burns with NexoBrid® in a non-burn referral center. All patients suffering from upper limb burns and admitted within 36 hours to the Hand and Microsurgery Unit of the ASST Sette Laghi from December 2016 to June 2018 were enrolled in the study. A retrospective analysis was performed, evaluating time to wound healing, time of hospitalization, and scar aesthetic appearance with patient and observer scar assessment scale (POSAS) and disabilities of the arm, shoulder and hand score (DASH). A total of 18 patients with burns involving the upper limb from December 2016 to June 2018 were treated. The mean TBSA% involved was 3%; 4 out of 18 patients suffered circumferential burns. The mean POSAS score was 14; the mean DASH score at 6-month follow up was 21, while it reduced to 11 at the last follow up visit. Enzymatic escharolysis is a novel, rapid and selective treatment option that allows early physiotherapy with overall satisfying functional results. We believe that enzymatic escharolysis should be considered, in most cases, as the standard of care in the treatment of upper limb burn wounds in non-burn referral centers., (Copyright © 2021 Euro-Mediterranean Council for Burns and Fire Disasters.)

Background and Objectives : Conservative treatment represents an essential pillar of lymphedema management, along with debulking and physiologic surgeries. Despite the consistent number of treatment options, there is currently no agreement on their indications and possible combinations. When dealing with unusual lymphedema presentation as in the genitalia (Genital Lymphedema-GL), treatment choice becomes even more difficult. The authors aimed to present their targeted algorithm of single and combined treatment modalities for rare GL in order to face this paucity of information. Materials and Methods : Data were collected from a prospectively maintained database since January 1983, and cases of GL that were managed in the authors' department were selected. Only patients that were treated in the authors' institution and presented a minimum follow-up of 3 months were admitted to the current study. Results : From January 1983 to July 2021, 19 patients with GL were recruited. All the patients were male, and their ages ranged from 21 to 73 years old (average: 52). Ten cases (52.6%) presented with ISL (International Society of Lymphology) stage I, five (26.3%) were stage II and four (21.1%) were stage III. GL was managed with conservative treatment (12 cases), LVA (LymphaticoVenous Anastomosis) (3) or surgical excision (4). In a mean follow-up of 7.5 years (range: 3 months-11 years), no major complications occurred, and all cases reached improvements in functional and quality of life terms. Conclusions : Contrary to the predominant thought of the necessity to avoid surgery in unusual lymphedema presentations such as GL, they can be managed using targeted multimodal approaches or by adapting well-known procedures in unusual ways to achieve control of disease progression and improve patients' quality of life.

Background: Orbital exenteration, the removal of the entire globe, eyelids, and orbital content, is indicated in extensive neoplastic disease involving the orbital region. Although a functional reconstruction of orbital exenteration defects is mandatory, aesthetic concerns need to be considered. Facial disfigurement following reconstructive surgery often leads to great discomfort and social retirement, which can limit social interaction. The aim of this study was to explore how the society perceives the aspect of patients who underwent orbital exenteration and subsequent reconstruction, comparing two different types of reconstruction: standard anterolateral thigh (ALT) or "sandwich" fascial ALT (SALT) free flap., Methods: An online survey was created based on four questions regarding the perception of reconstruction (discomfort at looking at that patient, perception of unhealthiness, hypothesis of social life impairment, etc); five possible answers were provided, ranging from "completely" to "not at all." The survey was administered to the general population and to medical students., Results: In total, 255 people participated to the survey (130 medical students and 125 people of the general population); a total of 245 surveys were considered eligible (10 were incomplete and then discharged). Statistical significance was found ( P < 0.001) regarding the better overall appearance of the SALT group over the ALT one., Conclusions: After analysis, the surgical outcome after SALT reconstruction has been found to be less disruptive in both groups, due to a reduced scar burden and a more pleasant orbital pocket. Our results encourage more research in the field of postexenteration reconstruction to achieve more aesthetic and social acceptability., Competing Interests: Disclosure: All the authors have no financial interest in relation to the contents of this article., (Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Testicular cancer is relatively uncommon, but at the same time, it is the most common solid tumor in men between the ages of 20 and 34 years. Seminoma represents the most frequently encountered germ cell tumors. Because orchiectomy is usually performed before chemotherapy, little is known about the effect of systemic chemotherapy on primary testicular tumors. Furthermore, the testis has always been considered a sanctuary site, an immune-privileged site in which inadequate exposure of the tumor to chemotherapy may occur. We report the case of a young patient with advanced seminoma with a complete testicular response after four cycles of cisplatin-based chemotherapy. Then, we performed a systematic review of the literature reporting the studies published to date on the topic., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Competing Interests: Conflicts of Interest None declared.

The aim of this systematic review is to understand which surgical procedure provides better results in terms of pain relief and function in the treatment of chronic exertional compartment syndrome (CECS) of the forearm.We searched Medline (PubMed), Web of Science, Embase and Scopus databases on 8 July 2020. Twelve studies were included in this review.We assessed the quality of the studies using the Coleman Methodological Score.Data on demographic features, operative readings, diagnostic methods, follow-up periods, type and rates of complications, survivorship of the procedure, return to sport activity, and outcome measures were recorded.In conclusion, compared to the other techniques, endoscopic fasciotomy delivers similar success rates and lower incidence of complications. Cite this article: EFORT Open Rev 2021;6:101-106. DOI: 10.1302/2058-5241.6.200107., Competing Interests: ICMJE Conflict of interest statement: The authors declare no conflict of interest relevant to this work., (© 2021 The author(s).)

Chronic exertional compartment syndrome of the forearm is a rare disease characterized by the recurrent onset of forearm pain and progressive weakness during exertion. Over the years many surgical techniques have been reported in literature: wide-open fasciotomy, mini-open fasciotomy, fasciotomy associated with fasciectomy, and mini-invasive endoscopic fasciotomy. Compared with traditional open techniques, mini-invasive techniques are characterized by minimal tissue trauma, less postoperative pain, faster recovery to normal activity and better esthetical result. We describe a mini-invasive endoscopic technique for the treatment of forearm chronic exertional compartment syndrome using the SmartRelease endoscopic tissue release system (MicroAire)., Competing Interests: Conflicts of Interest and Source of Funding: The authors report no conflicts of interest and no source of funding, (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Enhanced Recovery After Surgery (ERAS) perioperative pathways are safe and effective for patients undergoing gastrectomy. However, adherence to these protocols varies and is generally underreported. This retrospective study aimed to assess whether perioperative variables or deviation from ERAS items is associated with delayed discharge after gastrectomy., Methods: All patients undergoing gastrectomy at our institution were managed with a standardised perioperative pathway according to ERAS principles. The target length of stay was set as the ninth post-operative day (POD). All significant variables were derived from a bivariate analysis and were entered into a logistic regression to confirm their statistical value., Results: The study included 180 patients. Multivariate regression analysis revealed that incomplete immunonutrition, failure to extubate the patient at the end of surgery, intraoperative crystalloids >2150 ml and blood transfusion >268 ml, surgery duration >195 min, and failure to mobilise patients within 24 h from surgery were associated with delayed discharge. The logistic regression model was statistically significant (p < 0.001) and correctly classified 73.6% of cases. Sensitivity and specificity were 74.1% and 73.2%, respectively., Conclusions: These results seem clinically significant and consistent with those of previous studies. The reported perioperative variables showed a strong relationship with the length of hospital stay.

Objective: To assess whether perioperative variables or deviation from enhanced recovery after surgery (ERAS) items could be associated with delayed discharge after esophagectomy, and to convert them into a scoring system to predict it., Summary Background Data: ERAS perioperative pathways have been recently applied to esophageal resections. However, low adherence to ERAS items and high rates of protocol deviations are often reported., Methods: All patients who underwent esophagectomy between April 2012 and March 2017 were managed with a standardized perioperative pathway according to ERAS principles. The target length of stay was set at eighth postoperative day (POD). All significant variables at bivariate analysis were entered into a logistic regression to produce a predictive score. An initial validation of the score accuracy was carried out on a separate patient sample., Results: Two hundred eighty-six patients were included in the study. Multivariate regression analysis showed that American Society of Anesthesiology score ≥ 3, surgery duration > 255 min, "nonhybrid" esophagectomy, and failure to mobilize patients within 24 h from surgery were associated with delayed discharge. The logistic regression model was statistically significant (P < 0.001) and correctly classified 81.9% of cases. The sensitivity was 96.6%, and the specificity was 17.6%. The prediction score applied to 23 patients correctly identified 100% of those discharged after eighth POD., Conclusions: The results of this study seem to be clinically meaningful and in line with those from other studies. The initial validation revealed good predictive properties.